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New Student School Registration

Student 1

* Student Name

* Birthdate

* Grade

Early Learning (3-4 year olds)

Kol Tikvah Teens

Please list the names of anyone authorized to pick this child up from school.

Include name, relationship to child, phone number and if they can be contacted in the event of an emergency when the parents cannot be reached.

Allergies or other concerns we should be made aware of?

Student 2

Student Name

Birthdate

Grade

Early Learning (3-4 year olds)

Kol Tikvah Teens

Please list the names of anyone authorized to pick this child up from school.

Include name, relationship to child, phone number and if they can be contacted in the event of an emergency when the parents cannot be reached.

Allergies or other concerns we should be made aware of?

Student 3

Student Name

Birthdate

Grade

Early Learning (3-4 year olds)

Kol Tikvah Teens

Please list the names of anyone authorized to pick this child up from school.

Include name, relationship to child, phone number and if they can be contacted in the event of an emergency when the parents cannot be reached.

Allergies or other concerns we should be made aware of?

Student 4

Student Name

Birthdate

Grade

Early Learning (3-4 year olds)

Kol Tikvah Teens

Please list the names of anyone authorized to pick this child up from school.

Include name, relationship to child, phone number and if they can be contacted in the event of an emergency when the parents cannot be reached.

Allergies or other concerns we should be made aware of?

Family Information

FAMILY INFORMATION

* Parent(s) Name

* Cell Phone

* Email address

STANDARD SCHOOL PERMISSION

Please check all that apply

I do not give permission for my child(ren)'s photo to be used in the Temple bulletin and website with or without his/her name.

I give permission for our name address and phone number to be included and distributed on a grade level roster to encourage Temple friendships.

Account Details

E-mail

Enter your name and e-mail address for your confirmation

First Name

Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Checking Account

Name on the Account

Bank Name

Routing Number

Is usually located between the symbols on your check.

Account Number

Typically comes before the symbols. Its exact location and number of digits varies from bank to bank.

Confirm Account Number

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

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